Combined use of venetoclax and azacitidine in treatment of acute myeloid leukemia complicated with disseminated Fusarium infection: a case report

Abstract

Acute myeloid leukemia （AML） is a malignant clonal disease originating from hematopoietic stem/progenitor cells. Chemotherapy is the main treatment. If not effectively treated after 2 courses of standard treatment， these patients can be diagnosed with refractory AML. In this article， a case of refractory AML complicated with disseminated Fusarium infection receiving combined treatment of venetoclax and azacitidine was reported. The patient was diagnosed with AML （M5a） with DNMT3A， IDH2 and BCOR mutations， classified in the moderate group. Standard dose of IA regimen （deoxydaunorubicin + cytarabine） was ineffective， and additional homoharringtonine induction therapy remained ineffective. Subsequently， combined use of venetoclax and azacitidine was adopted and the severity of disease was alleviated. Complete remission was achieved after three cycles of venetoclax combined with azacitidine consolidation therapy. After the first chemotherapy， the patient presented with recurrent fever， purple induration with central necrosis in the upper and lower limbs， and visible subcutaneous liquid mass. Pathological examination suggested Fusarium infection. After amphotericin B combined with voriconazole as antifungal therapy， disseminated Fusarium infection was effectively controlled. This case prompts that combined use of venetoclax and azacitidine yields high remission rate in the treatment of refractory AML. Disseminated Fusarium infection is a rare fatal complication in AML patients after chemotherapy. Early diagnosis and effective antifungal treatment are effective interventions to improve the survival rate of patients.

Keywords

• |acute myeloid leukemia， refractory|venetoclax|azacytidine|disseminated fusarium infection